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Digital Radiographs and Photography
To take a digital X-ray, your dental prefessional will place a sensor on the tooth that looks like a piece of film. Once the picture is taken, your dentist can adjust the contrast and brightness of the image to find even the smallest area of decay. Other benefits of digital X-rays are decreased exposure to radiation and reduced time to develop photos, which helps eliminate treatment disruptions.
A panoramic radiograph allows your dentist to see the entire structure of your mouth in a single image. Within one large film, panoramic X-rays reveal all of your upper and lower teeth and parts of your jaw.
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What is apparent through one type of X-ray often is not visible on another. The panoramic X-ray will give your dentist a general and comprehensive view of your entire mouth on a single film, which other X-rays cannot show. On the other hand, you might need close-up X- rays to show a highly detailed image of a smaller area, making it easier for your dentist to see decay between your teeth. X-rays are not prescribed indiscriminately. Your dentist has a need for the different information that each X-ray can provide to formulate a diagnosis.
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At Pine River Dental Arts, we adhere strictly to the ALARA concept, which means we keep our radiograph exposure As Low As Reasonably Achievable to adequately diagnose your dental health and practice to the Standard of Care. We do this through the use of digital radiographs, digital photography, lead aprons, and radiograph frequency tailored to your specific dental needs.
Bacteria can live in your mouth in the form of plaque, causing cavities and gingivitis, which can lead to periodontal (gum) disease. In order to keep your mouth clean, you must practice good oral hygiene every day.
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Plaque is a sticky layer of material containing bacteria that accumulates on teeth, including where toothbrushes can’t reach. Many of the foods you eat cause the bacteria in your mouth to produce acids. Sugary foods are obvious sources of plaque, but there are others that you might not realize can cause harm. Starches—such as bread, crackers, and cereal—also cause acids to form. Plaque also produces substances that irritate the gums, making them red, sensitive, and susceptible to bleeding. This can lead to gum disease, in which gums pull away from the teeth and form pockets that fill with bacteria and pus. If the gums are not treated, the bone around the teeth can be destroyed and teeth may become loose or have to be removed.
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The best way to remove plaque is by brushing and cleaning between your teeth every day. Brushing removes plaque from the tooth surfaces. Brush your teeth twice per day with a soft-bristled brush. The size and shape of your toothbrush should fit your mouth and allow you to reach all areas easily. Use an antimicrobial toothpaste containing fluoride, which helps protect your teeth from decay. Clean between the teeth once a day with floss or interdental cleaners to remove plaque from between the teeth, where the toothbrush can’t reach. Flossing is essential to prevent gum disease.
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In addition to daily home-care, it is important to visit you dental hygienist and dentist regularly. For most patients, every 6 months is recommended, however, some patients may require more frequent visits based on individual oral health care needs.
Dental Hygiene and Periodontal Treatment
White Fillings (Composite Resin)
A composite filling is a tooth-colored plastic and glass mixture used to restore decayed teeth. Composites are also used for cosmetic improvements of the smile by changing the color of the teeth or reshaping disfigured teeth.
Following preparation, the dentist places the composite in layers, typically using a light specialized to harden each layer. When the process is finished, the dentist will shape the composite to fit the tooth. The dentist then polishes the composite to prevent staining and early wear.
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Prices vary, but composites can cost up to two times the price of a silver filling. Most dental benefit plans cover the cost of the composite up to the price of a silver filling, with the patient paying the difference. As composites continue to improve, insurance companies are more likely to increase their coverage of composites.
Aesthetics are the main advantage of composites, since dentists can blend shades to create a color nearly identical to that of the actual tooth. Composites bond to the tooth to support the remaining tooth structure, which helps to prevent breakage and insulate the tooth from excessive temperature changes.
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After receiving a composite, a patient may experience postoperative sensitivity. Also, the shade of the composite can change slightly if the patient drinks tea, coffee or other staining foods. The dentist can put a clear plastic coating over the composite to prevent the color from changing if a patient is particularly concerned about tooth color. Composites tend to wear out sooner than silver fillings in larger cavities, although they hold up as well in small cavities.
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Silver Fillings (Amalgam)
Most people recognize dental amalgams as silver fillings. Dental amalgam is a mixture of mercury, silver, tin and copper. Mercury, which makes up about 50 percent of the compound, is used to bind the metals together and to provide a strong, hard, durable filling. After years of research, mercury has been found to be the only element that will bind these metals together in such a way that can be easily manipulated into a tooth cavity.
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Mercury in dental amalgam is not poisonous. When mercury is combined with other materials in dental amalgam, its chemical nature changes, so it is essentially harmless. The amount of mercury released in the mouth under the pressure of chewing and grinding is extremely small and no cause for alarm. In fact, it is less than what patients are exposed to in food, air and water.
Ongoing scientific studies conducted over the past 100 years continue to prove that amalgam is not harmful. Claims of diseases caused by mercury in amalgam are anecdotal, as are claims of miraculous cures achieved by removing amalgam. These claims have not been proven scientifically.
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Dental amalgam has withstood the test of time, which is why it is the material of choice. It has a 150-year proven track record and is still one of the safest, durable and least expensive materials used to a fill a cavity. It is estimated that more than 1 billion amalgam restorations (fillings) are placed annually. Dentists use dental amalgam because it is easier to work with than other alternatives. Some patients prefer dental amalgam to other alternatives because of its safety, cost-effectiveness and ability to be placed in the tooth cavity quickly.
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Onlays and inlays are an alternative restoration which replaces only the damaged portion of the tooth. At Pine River Dental Arts, we utilized Cerec CAD/CAM technology to fabricate conservative porcelain alternatives to fillings and crowns when deemed necessary.
Restorations
A crown is a restoration that covers, or “caps,” a tooth to restore it to its normal shape and size, strengthening and improving the appearance of a tooth. Crowns are necessary when a tooth is generally broken down and fillings won’t solve the problem. If a tooth is cracked, a crown holds the tooth together to seal the cracks so the damage doesn’t get worse. Crowns are also used to restore a tooth when there isn’t enough of the tooth remaining to provide support for a large filling, attach a bridge, protect weak teeth from fracturing, restore fractured teeth or cover badly shaped or discolored teeth.
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To prepare the tooth for a crown, it is reduced so the crown can fit over it. Traditionally, an impression of the teeth and gums is made and sent to the lab for the crown fabrication. A temporary crown is fitted over the tooth until the permanent crown is made. On the next visit, the dentist removes the temporary crown and cements the permanent crown onto the tooth.
At Pine River Dental, a same-day, or Cerec porcelain crown is often an option for restoration. In this case, we make a digital impression of the prepared tooth and use CAD/CAM technology to design and fabricate your crown in one dental visit. Ask us if this option is right for you!
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Crowns should last approximately five to eight years. However, with good oral hygiene and supervision, most crowns will last for a much longer period of time. Some damaging habits like grinding your teeth, chewing ice or fingernail biting may cause this period of time to decrease significantly.
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To prevent damaging or fracturing the crown, avoid chewing hard foods, ice or other hard objects. You also want to avoid teeth grinding. Besides visiting your dentist and brushing twice a day, cleaning between your teeth is vital with crowns. Floss or interdental cleaners (specially shaped brushes and sticks) are important tools to remove plaque from the crown area where the gum meets the tooth. Plaque in that area can cause dental decay and gum disease.
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A dental bridge is a false tooth that is fused between two porcelain crowns to fill in the area left by a missing tooth. The two crowns holding it in place are attached onto your teeth on each side of the false tooth and the bridge is not removable because it is secured into place.
Crown and Bridge
3D Cone Beam CT Scan
At Pine River Dental Arts, we strive to offer the highest standard of care. To ensure this, we have recently added the OP300 Maxio Cone Beam CT scanner. Using ultra low-dose radiation technology, we are able to use the CBCT for precise implant placement, more accurate root canal therapy, and diagnosis of vague dental, head, and neck pathology.
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To better explain what Cone Beam CT ( CBCT ) is, we should first explain what regular CT is:
Computed tomography (CT) imaging, also referred to as a computed axial tomography (CAT) scan, involves the use of rotating x-ray equipment, combined with a digital computer, to obtain images of the body. Using CT imaging, cross sectional images of body organs and tissues can be produced. Though there are many other imaging techniques, CT imaging has the unique ability to offer clear images of different types of tissue. CT imaging can provide views of soft tissue, bone, muscle, and blood vessels, without sacrificing clarity. Other imaging techniques are much more limited in the types of images they can provide.
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To understand the difference between CT imaging and other techniques, consider an x-ray of the head. Using basic x-ray techniques, the bone structures of the skull can be viewed. With magnetic resonance imaging (MRI), blood vessels and soft tissue can be viewed, but clear, detailed images of bony structures cannot be obtained. On the other hand, x-ray angiography can provide a look at the blood vessels of the head, but not soft tissue. CT imaging of the head can provide clear images not only of soft tissue, but also of bones and blood vessels.
In layman’s terms, CBCT is a compact, faster and safer version of the regular CT. Through the use of a cone shaped X-Ray beam, the size of the scanner, radiation dosage and time needed for scanning are all dramatically reduced.
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A typical CBCT scanner can fit easily into any dental (or otherwise practice and is easily accessible by patients. The time needed for a full scan is typically under one minute and the radiation dosage is up to a hundred times less than that of a regular CT scanner.
Dental Implants
Dental implants are artificial tooth roots that can be surgically anchored to the jaw to hold a replacement tooth or a bridge in place. Implants are permanent and stable, and they look and feel just like natural teeth. Dental implants may also be used in addition to a denture for better stabilization.
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At Pine River Dental Arts, we utilize Biohorizons implants and other implant-related products. For more information, visit www.biohorizons.com/patients.aspx
Underneath your tooth’s outer enamel and within the dentin is an area of soft tissue called the pulp tissue. While a tooth’s pulp tissue does contain nerve fibers, it is also composed of arteries, veins, lymph vessels, and connective tissue. Each tooth’s nerve enters the tooth at the very tip of its roots. From there, the nerve runs through the center of the root in small “root canals,” which join up with the tooth’s pulp chamber. Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. Each tooth has at least one root canal, some containing multiple canals.
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When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.
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Root canal therapy is necessary because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate and the tooth may fall out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy. If you have the choice, it’s always best to keep your original teeth.
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A root canal is a procedure done to save the damaged or dead pulp in the root canal of the tooth by cleaning out the diseased pulp and reshaping the canal. The canal is filled with a rubberlike substance called gutta–percha or another material to prevent recontamination of the tooth. The tooth is then permanently sealed, with possibly a post and/or a crown made of porcelain or metal alloy. This enables patients to keep the original tooth.
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Once your general dentist performs tests on the tooth and recommends therapy, he or she can perform the treatment or refer you to an endodontist (a pulp specialist). Treatment usually involves one to three appointments.
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First, you will probably be given a local anesthetic to numb the area. A rubber sheet is then placed around the tooth to isolate it. Next, an opening is drilled from the crown into the pulp chamber, which, along with the root canal, is cleaned of all diseased pulp and reshaped.
Medication may be inserted into the area to fight bacteria. Depending on the condition of the tooth, the crown may then be sealed temporarily to guard against recontamination, the tooth may be left open to drain or the dentist may go right ahead and fill the canals.
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If you’re given a temporary filling, usually on the next visit it’s removed and the pulp chamber and canal(s) are filled with gutta percha or another material to prevent recontamination. If the tooth is still weak, a metal or fiber post may be inserted above the canal filling to reinforce the tooth. Once filled, the area is permanently sealed. Finally, a gold or porcelain crown is normally placed over the tooth to strengthen its structure and improve appearance.
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More than 95 percent of root canal treatments are successful. However, sometimes a procedure needs to be redone due to diseased canal offshoots that went unnoticed or the fracture of a filing instrument, both of which rarely occur. Occasionally, a root canal therapy will fail altogether, marked by a return of pain.
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Natural tissue inflammation may cause discomfort for a few days, which can be controlled by an over-the-counter analgesic. A follow-up exam can monitor tissue healing. From this point on, brush and floss regularly, avoid chewing hard foods with the treated tooth, and see your dentist regularly.
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The only alternative to root canal therapy is to extract the tooth; however, this alone can cause the surrounding teeth to move, resulting in a bad bite. Though a simple extraction may be perceived as less expensive, the empty space left behind will require an implant or a bridge, which ultimately can be more costly than root canal therapy.
Root Canal Therapy
The oral surgery we perform at Pine River Dental includes, but is not limited to tooth extraction, alveoloplasty, or bone shaping for better denture fit, bone augmentation to accommodate implant placement, and sinus grafting for implant placement. As general dentists, we perform oral surgery based on case difficulty as well as patient wishes. In many cases, patients may be required or request to see a specialist, or oral surgeon who performs the necessary surgery to prepare the patient for restorative treatment in our office.
Oral Surgery
Dentures
Dentures are removable replacements for missing teeth and adjoining tissues. Partial dentures are an option if you have some natural teeth remaining, as they fill in the spaces created by missing teeth and prevent other teeth from shifting position. Full dentures are appropriate if you have lost most or all of your teeth. “Immediate” dentures are inserted immediately following removal of the natural teeth, while “conventional” dentures are placed in the mouth about eight to 12 weeks after tooth removal.
In most patients, dentures may be stabilized with dental implants. This can eliminate many denture complications such as loosening due to bone loss, food getting under the denture, and movement which affects speech. Ask your dentist if this option is right for you!
From subtle changes to major repairs, your dentist can perform a variety of procedures to improve your smile. There are many techniques and options to treat teeth that are discolored, chipped, misshapen or missing. Your dentist can reshape your teeth, close spaces, restore worn or short teeth or alter the length of your teeth. Common procedures include bleaching, bonding, crowns, veneers and reshaping and contouring.
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These improvements are not always just cosmetic. Many of these treatments can improve oral problems, such as your bite.
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Bonding
Bonding is tooth-colored material used to fill in gaps or change the color of teeth. Requiring a single office visit, bonding lasts several years. Bonding is more susceptible to staining or chipping than other forms of restoration. When teeth are chipped or slightly decayed, bonded composite resins may be the material of choice. Bonding also is used as a tooth-colored filling for small cavities. Additionally, it can be used to close spaces between teeth or cover the entire outside surface of a tooth to change its color and shape.
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Crowns
Crowns, also known as caps, cover a tooth to restore it to its normal shape and appearance. Due to their cost, they are used in cases where other procedures will not be effective. Crowns have the longest life expectancy of all cosmetic restorations, but are the most time-consuming.
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Veneers
Veneers are thin pieces of porcelain or plastic placed over the front teeth to change the color or shape of your teeth. Veneers are used on teeth with uneven surfaces or are chipped, discolored, oddly shaped, unevenly spaced or crooked. Little or no anesthesia is needed. Veneers are used to treat some of the same problems as bonding.
This treatment may be an alternative to crowns. The procedure requires your dentist to take an impression of your tooth. Before the custom-made veneer is cemented directly onto the tooth, your dentist will lightly buff the tooth to compensate for the added thickness of the veneer. Once the cement is between the veneer and your tooth, a light beam is used to harden it. Porcelain veneers require more than one visit because they are fabricated in a laboratory. Veneers have a longer life expectancy and color stability than bonding.
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Contouring and reshaping
Tooth reshaping and contouring, is a procedure to correct crooked teeth, chipped or irregularly shaped teeth or even overlapping teeth in a single session. Tooth reshaping and contouring, is commonly used to alter the length, shape or position of your teeth. Contouring teeth may also help correct small problems with bite. It is common for bonding to be combined with tooth reshaping.
This procedure is ideal for candidates with normal, healthy teeth but who want subtle changes to their smile. Your dentist will take X-rays to evaluate the size and location of the pulp of each tooth to ensure that there’s enough bone between the teeth to support them.
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We can answer the questions you have about the techniques used to improve your smile. The condition of your teeth and your desired result often indicate the best procedure for you.
Cosmetic Dentistry
Generally, bleaching is successful in at least 90 percent of patients, though it may not be an option for everyone. Consider tooth bleaching if your teeth are darkened from age, coffee, tea or smoking. Teeth darkened with the color of yellow, brown or orange respond better to bleaching. Gray stains caused by fluorosis, smoking or tetracycline use can be lightened, but results are not as dramatic. If you have very sensitive teeth, periodontal (gum) disease or teeth with worn enamel, your dentist may discourage bleaching.
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At Pine River Dental Arts, we prefer the at-home bleaching method. This method involves a visit for impressions, custom tray fabrication, and a visit for tray fitting and instruction. While this method may be slower than some of the in-office options, we believe it yields reliable results, less sensitivity, and the patient retains the trays for a lifetime of touch-ups as needed.
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Tooth Whitening